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Breast Cancer

Pleomorphic Microcalcifications and BIRADS



I am 38 years old. I had a routine mammogram, which showed microcalcifications, so it was requested that I get a diagnostic mammogram. My BIRADs is 4B. I was told that I have pleomorphic microcalcifications and that there are 7 to 8 of them. I have sen the maximum amount is 4 or 5. What does it mean when I have more than that? There is not a lot of information, that I can find, about BIRADs 4B, and what I find out for "4" is conflicting. Can you please clarify what the number of calcifications has to do with the likelihood of a cancer diagnosis and how the 4B fits into it? I have a biopsy scheduled. I believe that this is called a stereotactic biopsy but the doctor told me that she cannot do the fine needle because my breasts are too small, so she has to do a small incisision to get the calcifications biopsied. Can you also advise what type of biopsy that may be and what may happen during the procedure?


4B is a subcategory of category 4. This means that the area to be biopsied is in the grey zone of being not totally suspicious but not benign enough to follow. The pleomorphic comment means that the calcifications do not all look alike and this can raise suspicion. If there are more than five calcifications in a group or tight cluster this may also cause radiologists to recommend a biopsy.

A stereotactic biopsy is most commonly recommended for biopsy of calcifications. It is a noninvasive way to biopsy calcifications in the breast. It is a table with a hole in it. You will lay on the table on your stomach and your breast will fall through the hole in the table. There is a mammogram machine under the table. Pictures of your breast will be taken. A computer will be used to help target the calcifications. The doctor will numb your breast with local anesthesia. A small incision is made in your skin, and a special needle is inserted into the tissue. Several tissue samples are taken and sent to the pathologist. A small metallic clip will be placed at the site of the biopsy in the case your surgeon needs to go back to this area in the future.

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Response by:

Donna  Plecha, MD Donna Plecha, MD
Assistant Professor of Radiology
School of Medicine
Case Western Reserve University